All this talk about glucose testing and you guys are so knowledgeable - I have a question.... I've had the 5 hour and 3 hour tests several times - before PN and after.... same results.... just borderline "normal"...

However, about 45 minutes after I drink the "glop" I start to shake and get really dizzy - so that each of these tests I've had to spend lying in a bed in the labs... the shaking lasts about two hours - the dizziness until its over.... and when its over - I literally cannot even get up until they give me something to (eat) drink.... how can this be normal? The docs only saw the end results on paper and said - look OK, I'm thinking - are they nuts? When I was healthy I ate tons every day and was very active and thin - could not miss a meal or I'd bite your head off until fed... after PN, now living on Ensure, I stilll have to have an early morning Ensure or LOOK OUT!

Glenn or Mrs D or ?? I certainly dont want to go thru this test again - but does tell you anything important about what may be happening with me?

(when ever I have blood work done - which has been pretty often lately - my glucose is always in range)

Thanks

It is coming down off the spike rapidly... I have had 2 long GTTs and the second
one I got really shakey with. major discomfort.

The stress in the place..I don't give up blood easily...it raises cortisol too.
And that is a factor as well. Add in the excess adrenergic responses, adrenalin, etc and you can get very upset. I have very small veins, and each attempt involved 3 or 4 sticks...very painful.

I understand there is a new version of the test that uses finger stick.
But insurance does not pay for it all...and it is not as accurate as the
major stick with the needle. You can opt for the more humane one and pay
the difference if it is available.

I understand completely... don't feel embarrassed etc. It happens to many.

I'm wondering if your gastric/transit issues may have something to do with that reaction.

Certainly what Mrs. D describes factors in, but in your case, I speculate that since the "glop" is one of the few thinigs your system can handle easily, it is rapidly absorbed by your hungry body cells--too rapidly--and you get a very quick spike and a very quick "crash". And then, of course, when due to the requirements of the test, you can't eat for a considerable while, you get those severe hypoglycemic symptoms . . .

Again, did they ever do the test with insulin levels as well? That might be instructive . . .do you have any numbers from any of these tests you can tell us?

One of the other things I wonder is, given your situation, just how much, or how little, glycogen you would have stored in your liver that could be released to offset such crashes. I'm thinking not a lot, as we know you're not exactly absorbing a lot of nutrition in general . . .in fact, more broadly, I would suspect you'd be prone to reactive symptoms of low blood sugar just day to day--does that seem to happen at times?

makes me really really wonder if what's labelled as 'normal' really is? Ages ago, I was labelled border hypoglycemic, and tests lately simply 'say' normal with no real indication whether it's all borderline lo, hi, whatever...at any particular point in time...sigh.

Those peaks and 'valleys' can be very irritating! Especially those valleys!Have any of your docs even considered your taking a glucose monitor and checking regularly over a few day period? Glenn, you've got me thinking here...Kmeb, are your liver function #'s totally normal? If so, at least SOMETHING's working right, I guess.

MrsD: do you have any reliable sources on 'cortisol'? I've seen, read about it a little bit in passing, but am a bit muzzy in that chemistry quarter.

Hope you all have at least one TRUE pain free moment today! - j

100–120 g of glycogen is stored in the liver and 1% of every muscle cell is glycogen. 2000kcal max of glycogen total for the human body.

when they give a person a 3 hour glucose tolerance test, why don't they do the insulin level test at the same time.

Is it a different drink, you have to take? I mean, is there a different protocol, or could a person drink the drink, then they take blood every hour (or whenever), then they can send the blood off to the lab for TWO things.
Glucose tolerance and Insulin levels.

Or am I completely off track?

Thanks,
Melody

By the way,

Alan just woke up and we're giving him a home-made glucose 3 hour test.
HIs fasting blood sugar is 81 and I just crushed 12 glucose pills and he drank it down with water and I'll test him every 30 minutes.



so the journey continues on this mysterious trip to find out WHY this man has had PN for over 18 years.
mel

Thanks for answers - I need to find out about insulin etc....

Actually, not to be gross - but my intestines since I got sick get very upset when I drink this stuff - lets just say it kinda "flys" thru me (yuck).... but enough must be abosbed on its rapid trip that its doing something - I've always gotten very shaky and dizzy and crabby and nauseus if I missed any meal at all - ever though! Up until the time I got sick I never left the house in the AM without eating something - even if meeting someone for breakfast (and breakfast couldnt just be fruit or something really light or I'd be hungry in a hour again - so would eat big fat muffin or waffles or eggs etc) .....and trying to work thru lunch etc was impossible - my co-workers and the poor people I had to interview or whatever were the victims if I had not had snacks in the am or taken 10 miinutes to wolf something down at about 11 in the aM - because I could no longer even think straight - so I'd get kinda mild symtoms (and then eat to stop them) - while during the test having nothing there was no way to ward them off.....

I know a doc had wanted me to get tested for adrenal exhaustion last year - but he never followed up on it and I should have - but was exhausted from other tests (irony here?)........ Could this maybe be part of problem?

Also, Mrs. D. - as a fellow "pin-cushion" (isnt it fun - not) - am I undertanding that a sharp spike or drop in blood sugar trioggers excess adrendalin? And is that triggered by blood sugar? Might explain a lot......

I think people vary ALOT in how they react to sugar.

This topic is quite active about children. My years on the ADHD forum at OBT,
were filled with parents remarking on the sugar causations for problematic
behaviors.

And you know, also, when I was freshly out of college, HYPOGLYCEMIA was
an actual disease/diagnosis then. We called it a "fad" disease.
Women especially were being diagnosed frequently with this. There was even a drug made for it--diazoxide (ProGlycem)
http://en.wikipedia.org/wiki/Diazoxide

It had severe side effects and is only used now in extreme situations.

The epidemic of diabetes now, has taken over for this decade. And I think it is directly proprotional to the use of high fructose corn syrup. This sweetener is is fruit juices today, that kids just consume in huge amounts (as well as sodas). It is hidden in many other foods also, because it is less expensive for the food industry to manufacture than using sucrose (from cane or beets). The diabetes epidemic is not a fad however, it is frighteningly REAL.

The fasting insulin test is easy and available now. And many doctors do not
put people thru the brutal GTTs as often anymore. Most doctors today are focusing on postprandial (right after eating) sugar levels, so multiple sticks are really not needed. This of course does not help with the hypoglycemics out there. Those of us who get shakey...know to avoid long time frames between meals, eat smaller more frequent ones, and less sugar, etc.

LURKING right about now!!!

The changes between Calcium and Postassium channels which triggers which what reactions...well, action/reaction...similar slitely different...DUH?

{Doc John, Proprietary stuff...Hope you get a healthy % of the ultimate profits resulting from all this brain-storming...BE SURE TO GET IT!!!!?}

I mean, it makes soo much sense! What we all do to avoid/avert such situations and the results or non-results of tests and test quality/paramaters surely are keys in the marginal aspects of glycemic influences on neuropathies...

I've kind of felt there were links...but these days HYPO Glycemic issues are literally 'clumped' into with the HYPER... Yes action/reaction is SIMILAR, but speed and actual timing of such actions is truly different? YIKES and, I'm not even a chemist!

I guess, does anyone ELSE out there feel the 'puzzle' pieces falling into place? I wouldn't like to be unique in this issue!

Mrs D You are GOODDD!!!!!!!!!!!!!!!!!!!!

Kmeb astute thinking to 'trigger' multiple brains into action!

Hugs and pain free many moments! - j

--into the whole endocrine picture, not just that involved in the glucose/endocrine dance.

The response people have to a given amount of glucose will vary widely--both due to individual differences such as muscle mass, amount of body fat, genetics (especially, as Kmeb alludes to, alimentary transit time) . . .and it can vary quite widely in an individual from situation to situation.

Moreover, the picture is tied in to the action of other hormones, as well--cortisol especially (this tends to make excess glucose get deposited as fat, particularly in the abdomen and hips, when it is not utilized--and this contributes to the insulin resistance cycle, as muscle utilizes much greater amounts of glucose--and thus insulin--for its energy needs than fat cells). And yes, adrenaline (epinephrine) release can be triggered by sudden stress, such as a drop or spike in glucose levels, and it tends to itself have a very seesaw effect. The sympathetic nervous system that sets off the adrenals is the "fight-or-flight" mechanism of the body, and the adrenal signals cause the liver to release glycogen, which is converted to glucose. In essence, the body is preparing for rapid action, and thinks it needs fuel. If this fuel is not consumed in action, however (and how often is it in the modern world), the glucose hangs around in the bloodstream long enough to percipitate an insulin reaction, followed often by a major plunge in serum glucose concentration, resulting in hypoglycemia and fatigue. (Bottom line--unreleased stress is not good for your endocrine system and a lot of other things.)

It's a very complicated picture even in "normals"--and those of us with neural problems, with the signal disruptions that can cause, complicate it still further.

Oh--quick answer, Mel: they can do insulin levels with the same blood samples as they're doing the glucose levels with; no other modificiations in the test are necessary. Thing is, docs have to include insulin levels in their instructions; labs don't do this automatically (insurance costs, again)--though they probably should; the patterns of glucose level and insulin level, examined together, can often provide more insight than looking at either one alone.